Diphtheria: Causes, symptoms, prevention, what you need to know

Diphtheria is a highly contagious bacterial infection that poses a significant public health threat, particularly in regions with low immunization coverage.

The disease, caused by Corynebacterium diphtheriae, primarily affects the respiratory system but can also impact the skin, eyes, and genitals.

In severe cases, diphtheria can lead to life-threatening complications, making timely prevention and treatment essential.

In recent years, Nigeria has experienced a resurgence of diphtheria, prompting increased surveillance and vaccination efforts.

Causes and symptoms

Diphtheria develops when Corynebacterium diphtheriae releases a toxin that damages tissues in the body. The infection typically manifests in the respiratory tract but can also cause skin infections.

Common symptoms of Diphtheria

Symptoms usually appear between 2 and 10 days after exposure to the bacteria. Early signs may include:

• Fever and chills
• Sore throat and difficulty swallowing
• Runny nose, often with a foul-smelling discharge
• Swollen lymph nodes in the neck (bull neck)
• Hoarseness and breathing difficulties

A hallmark of respiratory diphtheria is the formation of a thick, greyish-white membrane (pseudomembrane) in the throat, which can obstruct the airway and cause suffocation if not treated promptly.

In severe cases, diphtheria can lead to complications such as myocarditis (inflammation of the heart), nerve damage, kidney problems, and even death.

How it spreads

Diphtheria spreads easily from person to person through:

1. Respiratory droplets: When an infected person coughs or sneezes, the bacteria can be inhaled by those nearby.

2. Direct contact: The infection can spread through close contact with open sores or ulcers on an infected person.

3. Contaminated objects: Touching surfaces or personal items (such as towels or clothing) contaminated with diphtheria bacteria can also lead to infection.

4. Asymptomatic carriers: Some individuals may carry the bacteria without showing symptoms but can still spread the disease.

Given its highly contagious nature, diphtheria outbreaks can escalate quickly, particularly in crowded or unsanitary conditions.

The Diphtheria situation in Nigeria

Nigeria has witnessed a troubling increase in diphtheria cases in recent years, with outbreaks reported in several states, including Kano, Yobe, Katsina, and Lagos.

The resurgence has been linked to a decline in vaccination rates, misinformation about vaccines, and challenges in healthcare access, especially in rural areas.

One of the most notable outbreaks occurred in Lagos State, where cases were confirmed at King’s College Annexe, Victoria Island.

In response, the Lagos State Government launched an emergency vaccination campaign to curb the spread of the infection among students and staff.

The Nigeria Centre for Disease Control and Prevention (NCDC) has been actively monitoring and responding to diphtheria cases across the country. Measures taken include:

• Enhancing disease surveillance and case reporting
• Providing diphtheria antitoxin and antibiotics for treatment
• Strengthening routine immunization programs
• Educating the public on prevention strategies

However, despite these efforts, challenges remain in reaching all at-risk populations, particularly in regions with limited healthcare infrastructure.

Who is most at risk?

Certain groups of people face a higher risk of contracting diphtheria, including:

Unvaccinated children and adults: Individuals who have not received the diphtheria vaccine are the most vulnerable.

People living in crowded environments: Overcrowded housing increases the likelihood of disease transmission.

Individuals with poor sanitation and hygiene: Poor living conditions can contribute to the spread of bacteria.

Healthcare workers and caregivers: Those exposed to diphtheria patients are at risk if not adequately protected.

Prevention

The most effective way to prevent diphtheria is through vaccination.

Nigeria’s routine immunization schedule includes three doses of the pentavalent vaccine (which protects against diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae type B).

These doses are administered at:

1. 6 weeks of age

2. 10 weeks of age

3. 14 weeks of age

Additionally, booster doses are recommended throughout life to maintain immunity.

To further reduce the risk of diphtheria outbreaks, the NCDC urges:

• Parents to ensure children receive all three doses of the pentavalent vaccine as part of routine immunization.
• Healthcare workers to remain vigilant and quickly identify symptoms of diphtheria in patients.
• Prompt isolation of suspected cases and immediate reporting to local health authorities.
• Close monitoring of individuals exposed to diphtheria, with preventive antibiotic treatment if necessary.
• Vaccination of healthcare workers and others at high risk of exposure.

Treatment of Diphtheria

Diphtheria is a medical emergency that requires immediate intervention. Treatment typically involves:

• Administration of diphtheria antitoxin to neutralize the bacterial toxin.
• Antibiotic therapy (such as erythromycin or benzylpenicillin) to eliminate the infection.
• Supportive care, including oxygen therapy, IV fluids, and mechanical ventilation in severe cases.
• Hospital isolation to prevent further spread of the disease.

Without timely treatment, diphtheria can lead to severe complications or death, making early diagnosis and intervention critical.